Evaluation and diagnosis of common causes of foot pain in adults
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editor
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Foot pain is a common problem among adults. According to the Framingham population study of older adults, approximately 19 percent of men and 25 percent of women have significant foot pain on most days of the week that often limits their ability to function . The authors of this study recommend that clinicians include a foot examination as part of their routine evaluation of older patients. However, many clinicians may not be adequately prepared to perform such an examination as their training in the diagnosis and care of foot problems is limited .
This topic reviews the common causes of foot pain in adult patients, including the frequency of problems in specific populations. Conditions are organized by location, including the forefoot, midfoot, and rear foot. Examination focuses on visual inspection of the foot. The appearance of many common foot conditions can lead the clinician to the correct diagnosis. A detailed approach to the diagnosis of forefoot pain is provided separately. (See "Evaluation and diagnosis of common causes of forefoot pain in adults".)
EPIDEMIOLOGY AND RISK FACTORS
Certain populations appear to be at increased risk of developing foot pain. These include: older adults, the obese, active adults who participate in sports that involve running and jumping, active military personnel, and those engaged in certain occupations [3-7].
In a multiethnic sample of 784 community dwelling adults older than 65 years, 30.9 percent had tenderness to palpation of the foot. In addition, minor foot disorders affected the majority of individuals, including toenail disorders (74.9 percent), minor toe deformities (60 percent), corns and calluses (58.2 percent), and bunions (37.1 percent). Skin problems, including fungal infection, cracking, maceration between toes, and minor cuts, affected greater than one-third of individuals. Gender differences were noted, with women having greater problems with bunions, corns, and calluses. In addition, racial and ethnic differences were noted for flat feet, corns and calluses, toe disorders, and other physical findings, although additional studies would be needed to clarify these findings .
Several studies document a significant burden of disability and impaired quality of life among middle aged and older adults with foot pain. In a meta-analysis of 31 studies including 75,505 participants, 24 percent experienced frequent foot pain . Forefoot pain was most common and women appeared affected more frequently than men. In affected individuals, two-thirds reported moderate disability secondary to this pain. In an older cohort of 301 community-dwelling patients aged 70 to 95 years, 36 percent reported disabling foot pain; foot pain had a strong association with depression and low well-being scores on a standardized symptom inventory .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EPIDEMIOLOGY AND RISK FACTORS
- ANATOMY AND BIOMECHANICS
- Basic foot anatomy
- Basic foot structure and biomechanics
- ANATOMY-BASED APPROACH TO DIAGNOSIS
- Forefoot pain
- Midfoot pain
- Hindfoot (or rear foot) pain
- Additional ultrasound resources
- SPECIFIC CONDITIONS BY ANATOMICAL REGION
- Forefoot clinical conditions
- Midfoot clinical conditions
- - Medial arch (navicular) injury
- - Extensor tendinopathy of the foot
- - Tarsometatarsal bossing
- - Cuboid subluxation
- - Base of fifth metatarsal
- - Dorsal foot ganglia
- - Plantar fibromatosis (Ledderhose disease)
- Rear foot clinical conditions
- - Plantar fasciitis
- - Achilles tendon insertion and Haglund’s deformity
- - Tarsal tunnel syndrome
- - Peroneal tendon injury
- - Tibiotalar articulation and anterior and posterior ankle impingement
- - Sinus tarsi syndrome
- - Piezogenic papules
- - Heel contusion
- SUMMARY AND RECOMMENDATIONS